Fate of Patients with Adenocarcinoma of the Esophagus and the Esophagogastric Junction: A Population Based Analysis with Special Reference to Different Treatment Modalities
Abstracts
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The fate of individual patients with adenocarcinoma of the esophagus and the esophagogastric junction is lacking at a population level, since the reported series of adenocarcinoma near the esophagogastric junction (Siewert I and II) are selected from specialized centers. Primary data of patients with adenocarcinoma of the distal esophagus or the gastroesophageal junction in two (Finnish) health care districts were retrieved from the Finnish Cancer Registry with controlled coverage of more than 99% of these cases. The fate of all 402 patients treated because of adenocarcinoma of the esophagus and the esophagogastric junction between 1990 and 1998 in 23 units could be analyzed after comprehensive checking of patients' medical records. The actuarial five-year-survival rate of all patients was 13 %. Patients (n=76/18.9%) without treatment had a median survival of 36.5 days (0-2077 days). With palliative treatment (n=136/33.8%), mainly either endoscopic or oncological, median survival was 116.5 days (0-1816 days) and with exploratory operation (n=19/4.7%) 211 days (113-812 days). The resectability of all 402 patients was 32.5% and 90.0% (171/190) of operated patients. The median survival after esophageal resection (171/42.5%) was 537 days (2-3085 days). The five-year-survival rate after esophageal resection including the 8.8% of operative mortality was 29% in this unselected material. Patients who underwent esophageal resection with two-field lymphadenectomy (operative mortality 7.1%) had the best chance for cure and long-term survival compared to less extensive operations (survival including all deaths: 49% vs. 23% at five years, p=0.005; survival including only cancer deaths: 53% vs. 29%, p=0.036). In follow-up 10.6% of operated patients died without any evidence of disease recurrence. Although the overall prognosis of adenocarcinoma near the esophagogastric junction is poor, a substantial percentage of patients who are eligible for major surgery have a chance to survive long-term. These patients should be offered a chance for radical surgery with two-field lymphadenectomy. |
